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Predictors of length of hospital stay after total hip replacement
Kashif Abbas1, Masood Umer, Irfan Qadir
1Department of Orthopaedic Surgery, Aga Khan University Hospital, Karachi, Pakistan.
Insights
Patient age over 65, female gender, and higher American Society of Anesthesiologists (ASA) grades predict longer hospital stays after total hip replacement (THR). Identifying these factors aids in planning care for patients needing extended rehabilitation.
Area of Science:
- Orthopedic Surgery
- Health Services Research
Background:
- Total hip replacement (THR) is a common procedure.
- Optimizing hospital length of stay (LOS) is crucial for resource management and patient outcomes.
Purpose of the Study:
- To identify key predictors of prolonged hospital stay following elective unilateral total hip replacement.
- To control for potential confounding variables in the analysis of LOS.
Main Methods:
- Retrospective review of 199 consecutive elective unilateral THR cases.
- Data collected included patient demographics, comorbidities, surgical and anesthetic factors, and length of hospital stay.
- Multiple regression analysis was used to determine predictors of prolonged stay (≥12 days).
Main Results:
- The median length of hospital stay was significantly longer for women, patients over 65 years, and those with American Society of Anesthesiologists (ASA) grades 3 and 4.
- Predictors for prolonged hospital stay (≥12 days) were identified as patient age >65 years, female gender, and ASA grades 3 and 4.
- A significant proportion of patients with prolonged stays presented with two or all three of these risk factors.
Conclusions:
- Prolonged hospital stay after THR is largely determined by patient case mix.
- The identified predictors (age, gender, ASA grade) can help healthcare providers anticipate and plan for patients requiring longer rehabilitation and increased care post-THR.
Purpose:
To identify variables affecting length of hospital stay after total hip replacement (THR) while controlling for potential confounders.
Methods:
Records of 199 consecutive elective unilateral THRs were reviewed. Clinical and demographic data including age, gender, body mass index, comorbidities, surgical factors (surgical approach, type of prosthesis, use of cement, operating time), anaesthetic factors (type of anaesthesia, ASA physical status), and length of hospital stay were recorded.
Results:
64% of patients left hospital within 12 days, 28% within 3 weeks, and 8% after 3 weeks. The median length of hospital stay was longer in women than men (11.5 vs. 9 days, p=0.009), in patients aged >65 years than those younger (13 vs. 9 days, p<0.0001), and in those with American Society of Anesthesiologists (ASA) grades 3 and 4 than grades 1 or 2 (14 vs. 9 days, p<0.0001). A greater proportion of women than men (45% vs. 27%, p=0.007), patients aged >65 years than those younger (61% vs. 37% or 24%, p<0.0001), and those with ASA grades 3 and 4 than grades 1 and 2 (68% vs. 25%, p<0.0001) stayed 12 days or longer. In the multiple regression analysis, the predictors for prolonged hospital stay (12 days or more) were patient age >65 years (p<0.003), female gender (p<0.05), and ASA grades 3 and 4 (p<0.0001). Of the 72 patients with prolonged stay, 7% had no, 26% had one, 42% had 2, and 25% had all 3 predictors.
Conclusion:
Prolonged hospital stay after THR is largely predetermined by case mix. Our study helps to identify individuals who need longer rehabilitation and more care.